View full sizeRepublican leaders from the Ohio House unveiled a budget plan Tuesday that stripped out a proposal from Gov. John Kasich to expand Medicaid to the state's working poor. PD file

With Sarah Jane Tribble, Plain Dealer reporter

A proposal to expand Medicaid to cover working poor in Ohio was stripped out of the budget plan unveiled Tuesday by House Republicans, but the issue most certainly isn’t dead.

House Speaker William G. Batchelder portrayed the decision as one driven by too little time and too much confusion about Gov. John Kasich’s plan to try to leave it in the budget, although some agreement could still be worked out.

Advocates for the expansion -- ranging from the medical community to religious and social organizations to groups representing businesses -- had a louder response.

They pledged to pressure lawmakers and take the fight to the Statehouse, starting with a rally Thursday, until expansion is approved.

“We cannot accept putting politics before people. Our coalition is filling up buses to go down to Columbus on Thursday to make sure the legislature knows how important Medicaid expansion is to Northeast Ohio,” said Donna Weinberger. She is a spokeswoman for Greater Cleveland Congregations, which includes more than 20,000 members of 40 churches, synagogues and mosques, and a mental health practitioner from Solon.

Others were puzzled that there could be any confusion.

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"I frankly don't think they have taken any of the facts regarding Medicaid expansion into account. I haven't heard one credible argument for not including Medicaid expansion in the budget," said Oliver Henkel, the Cleveland Clinic's chief government relations officer.

He called the House’s announcement "a truly remarkable and inexplicable decision.”

Henkel and others said they would continue to work on lawmakers, noting that the deadline for approving the budget is still two and a half months away.

"This process isn't over," said John Corlett, vice president of government relations and community affairs at MetroHealth Medical Center in Cleveland. “We have time."

Corlett said legislators he has spoken with are "very inquisitive" and he believes there is some middle ground to be reached.

Legislators need to understand the impact of not expanding Medicaid, said Keith Lake, vice president for government affairs for the Ohio Chamber of Commerce. One study found that small businesses could face penalties ranging from nearly $60 million to almost $90 million a year for having uninsured employees who, without the expansion, would not be able to enroll in Medicaid.

“I think we continue to educate. That’s been our goal all along.”

In the budget he sent to the House early in February, Kasich proposed expanding Medicaid to cover those who earn up to 138 of the federal poverty level. Under the Patient Protection and Affordable Care Act, the federal government would cover all the cost of newly eligible enrollees for three years and then 90 percent of the cost in future years. Expanding the program in Ohio would add about 275,000 people.

A non-partisan report released in January by the Health Policy Institute of Ohio found that the $13 billion in Medicaid funding from the federal government as well as increased local revenue and sales tax on payments to Medicaid managed care plans would mean Ohio would gain money from the expansion.

Kasich has also argued Ohio should do it because it is the right thing to do.

It’s no secret that it has met resistance from conservative House members from his own party who don’t like the expansion of the government health program, don’t like the expanding national debt and don’t trust the government to live up to its agreement.

That last point is one that is a rub with some House members, said Mike Dittoe, a spokesman for the House majority caucus.

“Then what does Ohio do? We’d have people on an assistance program” that the state couldn’t just cut loose, he said. The fear is that the state could be on the hook for an expensive program.

That’s politics getting in the way of the decision, said Bill Ryan, former state Medicaid director and now executive director of the Northeast Ohio hospital group Center for Health Affairs. Republicans in the House, he said, have been "desperately trying to find a reason not to do this, to the point that they have clung to mythology in the face of facts and data."

Northeast Ohio's largest hospitals have steadfastly lobbied for the expansion since Kasich's February budget announcement. At times, Ryan said "I felt like I was talking to a 3–year old trying to get them to eat their vegetables. There is no fiscally responsible position other than to go forward” with expansion.

Batchelder acknowledged Tuesday that in the House, where Republicans enjoy an overwhelming majority, the votes weren’t there to support the expansion now.

“My assessment is that it’s about 20, 20, 20,” he said. “Twenty people might shoot themselves before they voted for it. Twenty people might have indicated to me that they’re for doing something because we have too many people with problems out there to do nothing. And then we have 20 people who are saying ‘if we don’t know any more than this, I don’t know how you count on us to vote either way.’ “

The House plan does include an increase of $50 million to aid mental health agencies and agencies that provide addiction services, said Rep. Ron Amstutz, a Wooster Republican who chairs the House Finance Committee. It also includes more Medicaid funding to cover an increase in enrollees expected as more people become aware of the Affordable Care Act.

Batchelder said the House would continue to work on the governor’s proposal with the Senate, which likely will get the budget bill later this month.

“We will be working together on an ongoing and constant basis,” he said. “Hopefully we will have, before July 1, some sense of what the federal government is going to do.”

At his budget unveiling last month, Kasich said that federal officials had expressed a willingness to give Ohio some flexibility. That flexibility could make it an easier sell with the Legislature

One possibility being discussed was to allow those in the newly expanded population be allowed to use Medicaid money to purchase their individual coverage through insurance exchanges that will be set up for Ohio.

Tuesday the administration reinforced its support for the expansion.

“It’s clear that support isn’t there right now among House Republicans to extend Medicaid coverage, but it’s the right decision for Ohio. Not doing so will hurt our economy, make Obamacare's impacts worse and hurt vulnerable Ohioans who need care,” said Kasich spokesman Rob Nichols. “The House's proposed funds for mental illness and addiction addresses part of the problem, but it's not enough. Ohio's support for this needed change is diverse and broad and the governor will see this through to get it done."

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